Recommendations to Prevent Urinary Tract Injuries During Laparoscopic Hysterectomy: A Systematic Delphi Procedure Among Experts

Janssen, Petra F.; Brölmann, Hans A.M.; Huirne, Judith A F

doi:10.1016/j.jmig.2011.01.007

Cited by 50 publications

(26 citation statements)

References 35 publications

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“…Stents are, however, easy to insert and improve the identification of the ureters. In the Delphi study by Janssen et al, the experts did not reach consensus regarding the additional value of ureter stents during LH [21]. …”

Section: Resultsmentioning

confidence: 99%

Laparoscopic hysterectomy for benign indications: clinical practice guideline

Sandberg

Hehenkamp

Geomini

et al. 2017

Arch Gynecol Obstet

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PurposeSince the introduction of minimally invasive gynecologic surgery, the percentage of advanced laparoscopic procedures has greatly increased worldwide. It seems therefore, timely to standardize laparoscopic gynecologic care according to the principles of evidence-based medicine. With this goal in mind—the Dutch Society of Gynecological Endoscopic Surgery initiated in The Netherlands the development of a national guideline for laparoscopic hysterectomy (LH). This present article provides a summary of the main recommendations of the guideline.MethodsThis guideline was developed following the Dutch guideline of medical specialists and in accordance with the AGREE II tool. Clinically important issues were firstly defined and translated into research questions. A literature search per topic was then conducted to identify relevant articles. The quality of the evidence of these articles was rated following the GRADE systematic. An expert panel consisting of 18 selected gynecologists was consulted to formulate best practice recommendations for each topic.ResultsTen topics were considered in this guideline, including amongst others, the different approaches for hysterectomy, advice regarding tissue extraction, pre-operative medical treatment and prevention of ureter injury. This work resulted in the development of a clinical practical guideline of LH with evidence- and expert-based recommendations. The guideline is currently being implemented in The Netherlands.ConclusionA guideline for LH was developed. It gives an overview of best clinical practice recommendations. It serves to standardize care, provides guidance for daily practice and aims to guarantee the quality of LH at an (inter)national level.

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Section: Resultsmentioning

confidence: 99%

Laparoscopic hysterectomy for benign indications: clinical practice guideline

Sandberg

Hehenkamp

Geomini

et al. 2017

Arch Gynecol Obstet

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“…endometriosis. Subsequently, although the earlier mentioned Delphi study by Janssen et al [1] is the best evidence we have regarding the prevention of ureter injuries, it is important to realize that the recommendations on ureter injuries were established based on expert opinions rather than clinical evidence. This is substantiated by the analyses of 31 ureter injuries performed by the same author [16].…”

Section: Discussionmentioning

confidence: 99%

“…In gynecology, the importance of a uterine manipulator regarding the prevention of ureter injuries during laparoscopic hysterectomy (LH), has been highlighted [1]. This reduced risk with respect to ureter injury is reported in several studies [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

Haak

Alleblas

Nieboer

et al. 2015

Arch Gynecol Obstet

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Purpose This review aims to objectively assess the efficacy and safety of uterine manipulators as reported in scientific literature. Furthermore, it evaluates as to which manipulator best suits which surgical procedure. Methods PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search Premier, Science Direct and the MAUDE database were searched. Technical information was retrieved from the manufacturers. Results 25 articles covering 10 uterine manipulators were found. Studies regarding implementation and use of manipulators are scarce; only two surveys were found comparing different manipulators. Moreover, clinical evidence proving the efficacy of manipulators with respect to prevention of complications, inherent to laparoscopic surgery, does not exist. Conclusion The use of uterine manipulators is well established and it is clear that uterine manipulators offer the easiest way to handle the uterus during surgery. However, detailed information regarding efficacy and safety is scarce. Clinical evidence substantiating the assumed mechanism of prevention of ureter injuries was not found. Our review did not find the optimal manipulator. Some are more versatile than others and not all instruments are appropriate for all types of surgery. Therefore, gynecologists should choose the manipulator that best suits the type of surgery that is performed.

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“…An RoA of more than 70% suggested consensus, in line with other medical Delphi studies (Supporting Information Figure S1). 11,12…”

Section: Discussionmentioning

confidence: 99%